• Assess predictors of mortality in COPD exacerbation between men and women.
• Evaluate the clinical outcomes in acute exacerbation of COPD in women.
• Evaluate the validity of new scoring systems ( NIVO, DECAF, HACOR ) as a predictor for hospital outcome in acute exacerbation of COPD.
• Compare these new scoring system with the most widely used APACHE IV.
• Assessment of serum level of granulocyte colony stimulating factor ( GM-CSF) in detecting the severity of COPD exacerbation.

Inclusion Criteria:

• Patients with AECOPD leading to hypoxemia, hypercapnia and respiratory acidosis with pH < 7.35 and PaCO2 > 45 mm of Hg will be admitted to the respiratory intensive care unit (ICU) for NIV or the ward will be eligible for inclusion and not in need for mechanical ventilation

Exclusion Criteria:

• Requirement for emergency intubation.
• Other contraindications to NIPPV including cardiac or respiratory arrest; nonrespiratory organ failure (eg, severe encephalopathy, severe gastrointestinal bleeding, hemodynamic instability with or without unstable cardiac angina); facial surgery or trauma; upper-airway obstruction; inability to protect the airway and/or high risk of aspiration; and inability to clear secretions.(6)
• Age < 35 years.

Patients enrolled in the study will be subjected to the following:

A- Careful History Taking and clinical examination.

B- Laboratory investigations which include :

I. Complete blood count. II. Arterial blood gas. III. Liver & kidney function tests. IV. Blood sugar level & serum electrolytes. V. Serum granulocyte colony-stimulating factor ( GM-CSF)

C- Severity of illness assessed by:

I. NIVO Score ( Non-invasive outcomes score )

II. DECAF Score

III. HACOR Score

IV. ( Acute physiology and chronic health evaluation ) APACHE IV Score. 200 patients (100 females, 100 males) with acute exacerbation of COPD will be admitted to the RICU will be observed as regards temperature, blood pressure, respiratory rate, pulse, oxygen saturation, and arterial blood gas will be obtained on NIV.

colony-stimulating factor will also be assessed on the first day of admission and after weaning from NIV.